Should we charge our doctors for wasting our time in their office waiting rooms?

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We patients often find ourselves stuck in the waiting room, thumbing through months-old magazines or watching dreadful daytime-TV talk shows.

Several years ago, I left an ophthalmologist’s office after sitting more than an hour in the waiting room. I can’t remember exactly why I left, but it was probably because I had to get home to conduct an interview or I had an article deadline looming and couldn’t spare any more time away from my computer.

I’m sure I was also pretty, um, shall we say perturbed at a doctor who seemed to be telling her patients that her time was more valuable than theirs. After all, the office staff had told me that no, the doctor hadn’t been called away to deal with a medical emergency. She was just “running behind.”

This doctor had been similarly running behind with her patients during my previous visit to her office. That time I had waited 90 minutes before being ushered into an examining room.

So, on this second visit, I decided not to hang around. I told the receptionist why I was leaving, and then went home.

I never thought to send the doctor a bill for the wages I lost during that wasted hour in her waiting room. (Freelance writers only get paid for the hours they work.) I didn’t know I could. But that’s apparently what some people do — including the self-employed owner of a California public relations firm. She told MedPage Today reporter Kristina Flore that she billed her ophthalmologist $150 recently for making her wait 45 minutes past her appointment time. (She deducted that amount from her final bill.)

“Now, it’s funny,” the woman told Flore. “They’ll always give me a time when they know I’ll be the first appointment.”

Last month, Oregon family physician Dr. Pamela Wible blogged about a friend who does something similar. “If I’m kept waiting, I bill the doctor,” the friend said. “At the twenty-minute mark I politely tell the receptionist that the doctor has missed my appointment, and at the thirty-minute mark, I will start billing at $47 an hour.”

Wible told ABC News that she hands out gifts of soaps and lotions to patients when she’s running more than 10 minutes late. Other doctors, according to the ABC report, offer gift cards or even cash. Still others have started texting patients when they’re running behind.

Doctors respondPhysicians, of course, offer plenty of reasons (excuses?) — ones that have nothing to do with them, of course — for why we patients often find ourselves stuck in the waiting room, thumbing through months-old magazines or watching dreadful daytime-TV talk shows.

Some, apparently, blame inconsiderate patients who arrive late for appointments or who “add on complaints” during their visits, thus extending their appointments past the standard 15-minute mark and backing up the scheduling system.

Others blame the endless paperwork they say they have to fill out for insurance companies.

One doctor told ABC News that doctors run behind schedule because they “try to address the needs of each patient, and some patients come in sicker than anticipated, need more care [or] need to be hospitalized. It’s not because we are enjoying a latte, schmoozing with other doctors and watching the news in the breakroom.”

“If we are going to have a discussion as to the value of time, and patients want to be paid for theirs, then the change must encompass the physicians time, too,” said another doctor. “That means paying for after-hours advice, forms that are needed … or [paying] if you need more time than scheduled so the physician can pay all the patients who will now be late.”

Hmmm…. Feeling defensive, maybe?

Resolving the problemI’d be interested in hearing if any MinnPost readers have ever billed a physician for keeping them waiting long past their appointment hour. But perhaps that’s a tactic that doesn’t meld with our “Minnesota nice” image.

I have a footnote to my ophthalmologist story. The doctor called me the evening after I left her office to apologize. She said she and her physician colleagues were concerned about appointment delays and were trying to fix the problem. Could I describe to her exactly what happened? And did I have any ideas for how to improve the situation?

At my next appointment, I had to wait only about 10 minutes.

And the waiting-room magazines were up to date.

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Comments (14)

I’m not a Minnesota native, so “Minnesota nice” doesn’t resonate with me. I try to be friendly all the time, but there are limits, and while I appreciate your apologetic tone as my waiting time goes beyond half an hour, the apology does nothing to rearrange my own schedule. If you want ME to keep the appointment, then there’s a similar obligation for YOU to keep the appointment. Otherwise, “appointment” becomes a meaningless term. I don’t see any ethical problem in billing the doctor, dentist or any other medical professional who insists that I make an appointment, for wasting my time – or for canceling an appointment without giving me the 24 hours’ notice which they required if the situation were reversed, something that has happened to me twice.

During my many years in St. Louis, the guy who became my regular dentist kept me waiting 45 minutes for my first appointment – and knocked 25 % off the bill while apologizing. The previous patient had some unexpected problems, but the dentist felt ethically required to value the next patient’s time. It’s one of several reasons why he became my “regular” dentist. After that first time, and I saw him every six months for nearly 20 years, I never had to wait more than a few minutes.

One of my sisters is a physician, and another relative is an RN, so I’m well aware that the unexpected is a frequent visitor during a normal medical/dental office day.

It’s a delicate balancing act, but I’d argue that valuing the time of one’s patients goes with the medical career territory. At the very least, patients should be informed when they arrive that “Dr. ‘X’ “ is behind schedule – and a good estimate ought to be presented as to how far behind schedule “Dr. ‘X’ “ actually seems to be. The usual vague “The doctor is running a little behind” is totally unsatisfactory. Give me an idea of how far behind, so I can do what Susan did, and decide whether I’ll be able to stay, or will have to move on with my day because there are other things in my life.

The short answer, Susan, is that no, I’ve never billed a doctor or dentist for wasting my time. First, I didn’t think I could, and second, I didn’t think they’d pay, or reduce the bill, or otherwise acknowledge it. That doesn’t mean I haven’t WANTED to bill someone for wasting my time, but so far, I haven’t actually done it.

I was having to wait at the dentist’s office, which increased my use of sick time and backed up my appointments back at my office. After waiting about 20 minutes past my appointment time, I told the receptionist, I would have to leave because of my appointments waiting for me back at my office. Now that they understand my need to stay on schedule, they give me the first appointment in the morning or the first one after lunch.

I don’t think doctors are to blame for this. It’s the health organizations that think every patient’s visit can fit into a 20 minute time slot, which is how our HMO does things. If a single patient is late, needs more time for an explanation or care, then it just builds up over the day. I’d much rather have a patient, comprehensive visit with my doctor than a hurried one with an eye on the clock. And I’d rather be treated like a person than as a “unit” of time.

And let’s be real: haven’t we all been late to something because an unexpected event came up? I’m betting that Ms. Perry, like the doctors in her article, hopes for a little understanding when things don’t go quite as planned.

If I had to guess, I’d say blame lies in a combination of having appointments scheduled too close together and having unexpected things come up during appointments.

One time while at a doctor appointment, I sat in my paper gown on the examining table for about 45 minutes. I was feeling pretty enraged by the time the doctor showed up, but he explained to me his previous patient needed some extra time with him to discuss things going on in her life, and I was completely diffused. It helped to know my waiting wasn’t completely arbitrary or due to poor scheduling.

That said, why couldn’t doctor offices call patients an hour or so before their appointment and ask if they can bump your appointment back by X amount of minutes if they know they’re running behind.

I just finished my morning clinic, and today was on time for all patients. That doesn’t always happen. Sometimes a patient arrives so sick that I end up admitting him/her to the hospital, and spend a fair amount of time contacting the accepting team, making sure that no vital information is missed in a handoff, and ensuring that the most urgent issues are well known. Other times, I’m trying to explain the pros and cons of a difficult decision to a patient with mild dementia, and end up calling his son to make sure that the decision is accurately communicated, and that takes time.

I have the benefit of working in the VA system (no insurers to deal with, fabulous electronic record), but there is still the universal uncertainty that exists in medicine- the patient that is “planned” for 30 minutes may need much longer. I can’t brush off new serious problems when they present themselves, or tell a patient that “I’m sorry you’re still confused about how to treat your infection, we’re past time”, so I take as much time as needed. I then apologize to the next patient, and move on. Usually, as long as honest communication is used, most people will understand.

In some respect I think this post is really about getting our medical needs met. The current system is not organized around providing the care we as patients need and want. Instead it is to a large degree organized to make money while providing services at the discretion of the medical provider. This is not to say doctors and nurses and other providers don’t want to provide the service patients want. Its simply that the system – the reimbursement system, the way doctors are paid, the way insurance companies are operated – obliges providers to practice in a way consistent with these purposes.

If we want better service we need to change the system, not blame the providers. The first step is to consider what the purpose of the health care system should be, then begin to organize the system to meet that purpose.

My physician sister was chastised at a clinic where she worked (not any more) because she didn’t move patients through quickly enough. Transforming medicine from a public service to a corporate, profit-driven enterprise, has had quite a few unintended consequences, most of them unpleasant.

My wife is a provider and has all sorts of stories about why this happens.

The doctors aren’t making excuses. This stuff really does happen. Appointments get scheduled for 15 minutes. That’s enough for smallish problems but not for anything mildly complicated. The HMOs don’t seem to get that. Sometimes the schedulers schedule an inadequate amount of time for some visits. It’s probably human error.

And yes, patients really do bring up surprise problems during visits. When you schedule an appointment, it is up to you to explain what you need the visit for. If you hold back, you are not going to get enough time in your visit. If you bring up new complaints the day of, the doctor is perfectly within his or her rights to tell you to schedule another appointment. Most are too nice to do that, which leads to patient backlog.

Finally, when your doctor gives you a diagnosis and treatment plan, accept it and follow it. My wife has constant stories about belligerent patients who won’t accept her professional judgment. That sort of arguing wastes a lot of time. I’m sorry, but your two-day-old cold does NOT justify antibiotics and you aren’t going to get them. Listen to the doctor about why and learn something. End of story. Move on.

Providers and patients need to work together to fix this. Don’t lay it all on the doctors, they actually have very little control over it.

I have seen all the rationalizations given above for delayed appointments, but not one mentions systematic overbooking to insure a maximal revenue stream from the schedule of each doctor.

Do a little arithmetic with those office visit charges, and factor in the Medicare (and other systems) charges, consider the variations in actual appointment times and the occurrence of cancellations, etc. – and you’ll see what a difference overbooking can make in actual revenues. Then multiply times all the providers on your staff. It is a lot of money!

But there’s another factor. Recently, I was told to make an appointment to review some test results, which I did under protest at the insistence of the health care organization. I pointed out that this visit was not going to involve examination of the patient at all – no BP, pulse, no tests. The visit was purely for the sake of communication. It was quite unnecessary to turn this into a formal office visit.

So when I pointed out that the provider and I could communicate on the test results just fine on the phone without the inconvenience of an office visit, it of course fell on deaf ears. The difference between the two modes of communication, in this case, amounted to 1.5 – 2 hours of MY TIME (no such burden to the provider, natch).

When I actually met with the provider, she admitted that we could have accomplished the same communication on the phone without an appointment, and that it would have been more convenient, even for her – because I was willing to take her call anytime within a 3 hour timeframe, whenever she found a few minutes free.

However, she felt the phone communication could not have been billed under the same procedure code as an office visit, and in fact she was unsure if it could be billed at all!

So we are back to the issue of revenue, again.

I told her that I would not be put to this inconvenience in a similar situation in the future, and next time, it was going to be a phone call.

This article treats physicians as if they are a part of the service industry. I cannot understand why this article was written. Does the author not recognize that health care costs are a significant concern to our society? How would charging physicians for circumstances beyond their control improve the quality or lower the price of the care that is delivered?

The problem is overbooking, and don’t tell me the doctors can’t do anything about it. The more overbooking, the more money they make. That’s all.

My tactic so far has been to send them a personal letter that explains to them why I left after 15 minutes of waiting. That usually gets their attention and I usually *(not always) am not kept waiting after that. I hadn’t thought of billing them, and I like that idea. I intend to try it the next time this happens.

In my job, I would never get away with being chronically late for appointments, let along 90 minutes late. #5, nice try, but the fact is long waits are the norm, not the exception. You keep people waiting because you think you can get away with it. How much trouble would it be to tell your nurse to come out to the waiting area and tell the next patient what’s going on, and give an estimated wait time?

Never thought of that? Thought so. Since most patients will just such it up, you make more money with the current way, and that suits you fine.

In a similar vein, my doctor insisted I schedule an office visit before she would give me a particular Rx – For a ‘consultation.’ She came in the room, wrote out the Rx, handed it to me and asked if I had any questions. The appointment lasted about 3 minutes. The doctor left and I sat in the room and read my book. When the nurse came in, I told her I had paid for the room for another 12 minutes and I was going to use it. She left without comment.

I remember being the first patient of the day to see my gynecologist, being ushered into an exam room, and asked to remove my clothing and put on a gown for the exam. I sat there, gowned and freezing, for 45 minutes, then poked my head out the door and asked a passing nurse to come in. She came in and stammered a lame explanation for the wait, so I asked directly, “Is the doctor even in the building yet?” She answered honestly, “No.” Of course, I put on my clothes and left.

The doctor called later and apologized, but offered no real explanation. I suspected she just overslept. It was time then to seek out a physician who respects her patients and doesn’t ask her staff to cover for her. Fundamentally, we all want a doctor who cares about us.

Medicine is an inherently complex and unpredictable practice. The last thing you want to do is pressure doctors to “rush”, you want their full attention when their treating you.

Our health care system is an abysmal failure. The fact that that HMO demands are even a part of your doctor patient relationship adds dangerous and time consuming complexity to the whole process. If doctors could schedule even a half hour instead of 15 minutes for each appointment it would relieve a lot of these problems.

The only suggestion I can make under the circumstances is that when complication do arise, the doctor should be able to alert the receptionist who could let waiting patients know that a delay can be expected so they can decide whether or not to wait or reschedule. A doctor knows when something will take longer than 15 minutes. Offices put a lot of time into making sure you don’t forget your appointment, the could put some time into letting you know there are delays.